FEMA-EC940114 (2)� �
® "5zq
TheCRyWIthAB"ut'F""re BUILDING PERMIT APPLICATION
Building Inspections Division j
/� pp Print or Type in a Clear, Legible Manner
Job Address: (� n Q �, t_ 1 a,,.l l Date:
Lot: /J / Block: Subdivision: / J ' J J A n Phase or Section Number:
Owner: I 1 e- Ln \ - - , L.. n Address: Phone #:
Contractor: Address: Phone #:
Description of Work to be Done Class of Work: MXew ❑Addition ❑ Alteration ❑ Repair
of Building in Square Feet
First Floor s
Second Floor.
�L671WID
5
Other
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or abandoned for a period of 180
days at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other federal, state or local law
regulating construction or the performance of construction.
Signature\of Contractor or Authorized Agent Print Name ' - .
0 , )aa�E-R k" eu� AIRt
Electra ontractor Plumbing Con actor klecharLal Contractor
RIR - 1 !2/821
Value of Work
to be Performed
__a,
GRAY AREA FOR OFFICE USE
2293
ks
❑ Demolition
V��
ELEVATION CERTIFICATE Expires No May 31, O.M.B. May 31,-00»
1993
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMB).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
900 Brentwood Drive _
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
LOT 41, BLOCK A, VILLAGES OF COPPELL PH. IIIB
CITY
COPPELL STATE ZIP CODE
TEXAS
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
480170
0010
D
10-16-91
AE
(in AO Zones, use depth)
4.50.00
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [� NGVJD '29 ❑ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: ❑.❑ feet NGVD (or other FIRM datum—see Section B, Item 7)_
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level _1 .
2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of L_L L4-- j . Li feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of LLA ___I__� -1.1 1 feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L ❑ . ❑ feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is L_LJ . ❑ feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: N NGVD'29 ❑ Other (describe
under Comments on Page 2). (NOTE: I1 the elevation datum used in measuring the elevations is different than that used on
the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: 1_1 Yes LXX No (See Instructions on Page 4)
5. The reference level elevation is based on: 1XI actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: 1__]J_415P_j . _q feet NGVD (or other FIRM datum see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: �_LJ1�_� . �I feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31r MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones Al—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to break n -breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Featur eature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, m 'I a re
I certify that the information in Sections B and C on this certificate represents my best efforts t h tM�
1 understand that any false statement may be punishable by fine or imprisonment under 18 Sec 100`f.'!
ROLAND RODRIGUEZ
CERTIFIER'S NAME LICENSE NUMBER (or Aff I 0 Tvv r �V.0 �
ROLAND RODRIGUEZ q .*IAE GS 0.0 p
TITLE COMPANY NAME 10~�
MANAGER JAMES H. DOWDY LAND SURVEYO �
ADDRESS CITY STATE ZIP
1550 N o0a Hurst Texas 76054
SIGNATURE DATE PHONE
(817) 589-7107
Copies should be made of this Certificate for: Cco4unity official, 2) insurance agent/company, and 3) building owner.
COMMFNTS- The following Benchmark was used in determining referenced
elevation- Top operating nut of fire hydrant located on East side of
Allen Rd., 100' North of Chalfont Place.
Elevation- 456.93 ft.
Source- Shown on Subdivision Plat recorded in Vol.92218, Pg.3565, DRDCT.
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A v A A v
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCEBASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION or
a'}�4{i"I?ti.`,'s'M>r't;^ ;14,�i1�uy"', :.�•. .�;��.
�':. i:;',:•:. :;:: i'?i?::' !! `:,k.
•ADJACENT
BASE
BASE • "�".L4 REFERFNCE
FLOOD
FLOOD ;.^.�.
GRADE LEVEL
.��ri;;
ELEVATION
ELEVATION REFERENCE ADJACENT
LEVEL GRADE
..::Sr:;;•: i::;:. �.';:'.`:::.:':!::; �':: ':':�.r;•
ADJACENT
GRADE
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2
CITY
�FEIIIEWED
�aATE
s anu specifications . shall n0l
prov AructiOn ir, direct
'J�
i"letied topl,-03n -1-jes and
an b he Cit,
of Coppe,11 Bui!ding G(
Fl C"i vP- , t
'Mod"sCC C'
P ADVA -INAA L �&
1 =2 0,
-rinances
L07 41 BLOCK A
VILLAC-;E5 of COFFELL PHASE 111 5
COFFELL, TEXAS
IM -Y
CHESTER
HOW*
12-15-1993 08:05AM P.06
REFERENCE NO. 39970
LOT 41, BLOCK A, VILLAGES OF COPPELL PHASE IIIB, AN ADDITION TO THE CITY
OF COPPELL, DALLAS COUNTY, TEXAS.
"FORM SURVEY"
DEFOREST DRIVE
-- ---18.0' --
1/2" I.R. FND. �S.89°44'05" E.
- - /p,
N
3.3' - -- --� �
LOT 41
0.12 .,ACRES
�j 1/2" I.R. END.
�I
42 wl - 40
:U-)
o �
`n i
U-) FORMS
b I cn
20' BUILDING z C"
LINE _�-
10.9'
i-� -------iC�
II _ j 15' UTIL. ESM'T.
i_..L— _ _ — — —
N.89°44'05"W. 58.0'
1/2" I.R. FND. 1/2" I.R. FND.
NORTH
SCALE: 1 =30
900 BRENTWOOD DRIVE
SURVEYORS CERTIFICATION
FENCF OVERHEAD ELEC.I
E
TELEPHONE
— T —
CONCRETE
etc= (CONTROL MONUMENT)
The undersigned Registered Professional Land Surveyors certifies that; (A) this plat of survey ant the property description set forth heron are
a true and correct representation of facts found at the time an actual on–the–ground survey; (B) such survey was conducted by the surveyor, or
under his supervision; (C) all monuments shown hereon exist and the location, size, and type of material are correctly shown;
,*elk
�
4� �w:1 +
ROLANp RODRIGUEZ
JAMES H. DOW L. o. 7 f 4987
to q.
ROLAND IGUEZ, R.P.L. . No. 4987 •w••• ��
S Vit
1550 NORWOOD, SUITE 410
HURST, TEXAS 76054
(817) 589-7107
THIS SURVEY NOT VALID WITHOUT EMBOSSED SEAL & ORIGINAL SIGNATURE